Events before the diagnosis of a pneumothorax in ventilated neonates
M Watkinson, I Tiron
Neonatal Unit,
Birmingham Heartlands Hospital, Birmingham B9 5SS, UK
Correspondence to: Dr Watkinson watkinm{at}heartsol.wmids.nhs.uk
Accepted 6 July 2001
AIM
To examine the
relation of overventilation and other clinical events to the
development of pneumothoraces in ventilated neonates.
METHODSA case-control study.
RESULTSFifty three
(8.7%) of 606 ventilated neonates developed a pneumothorax. Eighteen
(34%) cases and 23 (43%) controls were unintentionally overventilated
(PaCO2 < 4 kPa) at some time before the
pneumothorax developed in the cases (odds ratio (OR) = 0.78, 95%
confidence interval (CI) 0.48 to 1.27). In the three hours before the
diagnosis of pneumothorax, more cases than controls were reintubated
(21/53 v 4/53; OR = 5.25, 95% CI 1.9 to
14.3), and also in seven cases (one control) the mean airway pressure
was increased, whereas in nine controls (no cases) it was reduced
(
2 = 12.0, df = 2, p = 0.001). Seven of 18 neonates diagnosed by transillumination had undergone no clinical
procedures before diagnosis compared with five of 35 diagnosed
radiologically (OR = 2.7, 95% CI 1.0 to 7.4).
CONCLUSIONSUnintentional
overventilation was not associated with pneumothoraces. In the hours
before diagnosis, there was increased clinical intervention, including
reintubation; this was less so in those diagnosed by transillumination.
The study did not elucidate whether such interventions caused the
pneumothorax or were secondary to a failure to diagnose it.
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Keywords: pneumothorax; ventilation; transillumination
© 2001 by Archives of Disease in Childhood
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